Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

Abstract

BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound (BUS) for the diagnosis of pediatric intussusception at a single institution.METHODS: Inclusion criteria were: 1) patients of 0-18 years old were seen in the pediatric emergency department (ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study (such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1 st 2009 to October 3 rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception. RESULTS:A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive (95%CI 66%-100%) and 94% specifi c (95%CI 79%-99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5 (95%CI 4.30%-63.21%) and 0 (95%CI 0-0) respectively. CONCLUSIONS: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.

Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

“…In this study, POCUS performed by pediatric emergency physicians seemed highly reliable (sensitivity, 100%; specificity, 95.6%; and accuracy, 97.8%) and useful (positive likelihood ratio, 23.0; and negative likelihood ratio, 0) in detecting intussusception. A previous study also showed a high degree of accuracy with 100% sensitivity and 94% specificity, even though it enrolled only 49 patients, which was a relatively small number [9]. Among the 92 patients with "suspicious" POCUS results in this study, 22 were confirmed as false positives, with a relatively low positive predictive value of 76.1%.…”

Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

“…In this study, POCUS performed by pediatric emergency physicians seemed highly reliable (sensitivity, 100%; specificity, 95.6%; and accuracy, 97.8%) and useful (positive likelihood ratio, 23.0; and negative likelihood ratio, 0) in detecting intussusception. A previous study also showed a high degree of accuracy with 100% sensitivity and 94% specificity, even though it enrolled only 49 patients, which was a relatively small number [7]. Among the 92 patients with "suspicious" POCUS results in this study, 22 were confirmed as false positives, with a relatively low positive predictive value of 76.1%.…”

“…Several studies have suggested that point-of-care ultrasound (POCUS) performed by pediatric emergency physicians could be a practical measure [6][7][8]. POCUS for detecting intussusception is relatively easy to learn and readily available in the ED [8][9][10].…”

Diagnosing Pediatric Intussusception Through Bedside Ultrasound by Novice Emergency Department Sonographers: A Case Report

“…However, there has been no agreement on what constitute as sufficient training for novice sonographers. The first study by Lam (Lam et al 2014) subjected the emergency physicians to a minimum 1 hr of didactic training on the use of bedside ultrasound using paediatric transducers. They did not go on to explain what the didactic training comprise of.…”

“…A retrospective review (Lam et al 2014) compared the accuracy of bedside ultrasound diagnosis of intussusception made by Emergency Physicians to the "formal" diagnostic study such as ultrasound, CT and barium enema performed in the Radiology Department. Out of 1631 of the medical records been reviewed in a single centre, 44 met the inclusion criteria.…”